Severity – Adjusted mortality from massive haemorrhage in trauma: Analysis in 3 periods of time

Abstract text (incl. references and figure legends)

Introduction: Haemorrhagic shock is the most common preventable cause of early mortality in polytrauma. The aim of this study is to analyse the incidence, mechanism, and severity-adjusted mortality of massive haemorrhage in our center. Methods: Descriptive, retrospective study of patients dying from massive haemorrhage included in our registry of severe trauma. Results of three successive periods between 1993-2021 were compared. Associated injuries, trauma scores and time to death was analysed. The probability of survival (Ps) was calculated according to NTRISS methodology. The focus was on potentially preventable deaths (PPD) and identification of deviations from clinical practice. Results: From 3.209 trauma patients admitted to hospital, 125 died from massive haemorrhage: 45/789(5.7%) in the 1st period, 66/1.270(5.1%) in the 2nd, and 14/1.150(1.21%) in the 3rd, showing a clear decrease in mortality over the years. Blunt trauma was predominant (84.8%). We found a significant higher RTS in the 3rd period (p0.054), and a higher ISS in the 1st period (p0.002). Mortality from massive haemorrhage from pelvic fractures increased over time (p0.00). A gradual decrease in the number of deaths in the first 24h (p 0,021) and in deaths occurring at the radiology suite were observed, with an increase in ICU deaths in the 3rd period (p0.013). The expected Ps>0.5 was of 29%, 39.5% and 50% respectively, with an overall misclassification rate of 38,6%. 52 (41%) PPD were detected with a decreasing tendency in the 3rd period. Conclusions: Mortality from severe haemorrhage has clearly decreased in recent years in our center, with the exception of pelvic fractures. However, the high misclassification rate of the NTRISS survival prediction model discards it as a useful objective tool to assess quality of care in this subgroup of patients. Careful review of deviations from clinical practice in this subgroup of trauma deaths remains the main tool for assessing the quality of care.

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